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illi <br /> „.----- <k PERM@T APPLICATION° <br /> /.h. BUILDING/MECHANICAL I PLu Fit[ MG I SIGN I SPRINKLER I DEMOI.OT(ON <br /> e�� CITY OF EVERETT PERMIT SERVICES <br /> 0 e•^-:' e o`d;;;; rl a 3200 CEDAR STREET,EVERETT,WA 98201 <br /> x4)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 3➢rite©Y Mack ick➢i*Only Please) PROJECT SITE➢Ci➢-)RMATE101a9 <br /> IIPROJECT SITE ADDRESS:,g3(7 .jY,t14v . (.Jt -7 PROPERTY TAX#: t;c9*moo ez -zoo <br /> IiL.E+aAL for new construction: Short Plat/subdivision Lot No. I,( (attach copy of long legal description) 8 ` ,27-0 <br /> 'I CONTACT IG FO➢a;WL `I°➢ON <br /> T- _ s <br /> DOWNER NAME: cif, i t j4 f 4-if- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /2.D,� /307 . r Se. A <br /> 11 CITY V C�j-7 // STATE W ZIP '7. 21)d° <br /> li <br /> PI#',NER PHONE: 42,% ' 7 z9/^ 6 /lt'c,-/ 'OWNER EMAIL: <br /> !CONTRACTOR NAME: Shift'-%( 4 / ply /7 if 077 /O/l/ GG C <br /> p;CONTR AC T OR ADDRESS: STREET ( 'f /30 a cgs. ---(.'' <br /> CITY 2— —ir— STATE,± (t 61-- ZIP?�/ AO c <br /> ,iCO fp f-5 LA <br /> NTRACTO :R PHONE: l- 1 A . _/ -CONTRACTOR EMAIL: 5 D4�/yCS 6 gm�r G CC il <br /> , <br /> CONTRACTOR LICENSE#((REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> IIPRiMARYCONTACT: I31OWNER ®.CONTRACTOR OTHER(Please Specify) 46ti of Geld06 <br /> CONTACT NAME: CONTACT PHONE: 17 -- 613s 2-7-/ 2 <br /> If-#1y( ��./G tc CONTACT EMAIL: 4- , -g C v'f �f �p/iY /L. (gip /Y <br /> .BUILDING..PERMIT APPLICATION <br /> Existing Use of Building: '^ Contract Price of Work:$ <br /> jProposed Use of Building: 12 Z Az -7 ivt 'CT.' Heat Source: G3Gas ❑Electric ❑Other <br /> Euilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: 1J ❑Commercial ❑Industrial <br /> Type of Protect: KNew ['Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition El Change of Use <br /> IIDESCRIPTION OF WORK: - <br /> j1 CaN-- 1 7v A/ G 5 C-�,' <br /> p W iU O0�U = to 2/,&T 7k -� �e "'� 1'I <br /> I4ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IEGNA,,;?➢tCAL PERMIT APPLICATION FLt.IMRING PERMIT APPLICATION <br /> Type of Project:A New _ Addn Alteration _Repair i Type o Protect: New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> '[{ - A/C-Air Handling Units Heat Pump - 5 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> E Gas Piping Boiler ' Lavatory(Wash Basin) Drinking Fountain <br /> ^ f Water Heater Refrigeration _ Shower Floor Drain <br /> g -. Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap . . <br /> l• — Gas Range Ducting _ i Dishwasher Roof Drains • <br /> ti J_Clothes Dryer Hookups Other: al Clothes Washer Medical Gas <br /> I JjRange Hood - Water Heater Other: • <br /> u Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> it <br /> fi • SPREN➢ LER1 SUPPRESSION SYSTEM <br /> II_________I Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / City of Everett Official Use Only <br /> 7t ( / / PERMIT# /1 ,1 /1 l �0 1 <br /> �/ lJ <br /> Owner/Authorized Agent Signature Dale (Revised 9/23/2016) <br />